|
TRAY SKIN SCRUB PREP PROVIDINE IODINE 4468
|
Facility
|
OP
|
$131.00
|
|
| Hospital Charge Code |
2963477
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.68 |
| Max. Negotiated Rate |
$524.00 |
| Rate for Payer: Aetna Commercial |
$117.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$112.66
|
| Rate for Payer: Aetna Managed Medicare |
$36.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$85.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$65.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$62.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$69.43
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$120.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$73.31
|
| Rate for Payer: Health EOS Commercial |
$116.59
|
| Rate for Payer: HFN Commercial |
$120.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$98.25
|
| Rate for Payer: Multiplan Commercial |
$104.80
|
| Rate for Payer: NAPHCARE Commercial |
$78.60
|
| Rate for Payer: Preferred Network Access Commercial |
$120.52
|
| Rate for Payer: Quartz Beloit One Network |
$64.19
|
| Rate for Payer: Quartz Commercial |
$85.15
|
| Rate for Payer: Quartz Medicare Advantage |
$78.60
|
| Rate for Payer: The Alliance Commercial |
$524.00
|
| Rate for Payer: WEA Trust Commercial |
$72.05
|
| Rate for Payer: WPS Commercial |
$97.03
|
|
|
Tray Spinal Anesthesia
|
Facility
|
IP
|
$575.00
|
|
| Hospital Charge Code |
3101767
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$281.75 |
| Max. Negotiated Rate |
$529.00 |
| Rate for Payer: Aetna Commercial |
$517.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$494.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$304.75
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Cigna Commercial |
$529.00
|
| Rate for Payer: Health EOS Commercial |
$511.75
|
| Rate for Payer: HFN Commercial |
$529.00
|
| Rate for Payer: Multiplan Commercial |
$460.00
|
| Rate for Payer: NAPHCARE Commercial |
$345.00
|
| Rate for Payer: Preferred Network Access Commercial |
$529.00
|
| Rate for Payer: Quartz Beloit One Network |
$281.75
|
| Rate for Payer: Quartz Commercial |
$345.00
|
| Rate for Payer: WEA Trust Commercial |
$316.25
|
| Rate for Payer: WPS Commercial |
$425.90
|
|
|
Tray Spinal Anesthesia
|
Facility
|
OP
|
$575.00
|
|
| Hospital Charge Code |
3101767
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$2,300.00 |
| Rate for Payer: Aetna Commercial |
$517.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$494.50
|
| Rate for Payer: Aetna Managed Medicare |
$161.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$373.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$287.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$276.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$304.75
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Cigna Commercial |
$529.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$321.77
|
| Rate for Payer: Health EOS Commercial |
$511.75
|
| Rate for Payer: HFN Commercial |
$529.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$431.25
|
| Rate for Payer: Multiplan Commercial |
$460.00
|
| Rate for Payer: NAPHCARE Commercial |
$345.00
|
| Rate for Payer: Preferred Network Access Commercial |
$529.00
|
| Rate for Payer: Quartz Beloit One Network |
$281.75
|
| Rate for Payer: Quartz Commercial |
$373.75
|
| Rate for Payer: Quartz Medicare Advantage |
$345.00
|
| Rate for Payer: The Alliance Commercial |
$2,300.00
|
| Rate for Payer: WEA Trust Commercial |
$316.25
|
| Rate for Payer: WPS Commercial |
$425.90
|
|
|
TRAY SPINAL ANESTHESIA B
|
Facility
|
OP
|
$261.00
|
|
| Hospital Charge Code |
2969065
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$73.08 |
| Max. Negotiated Rate |
$1,044.00 |
| Rate for Payer: Aetna Commercial |
$234.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$224.46
|
| Rate for Payer: Aetna Managed Medicare |
$73.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$169.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$130.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$125.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.33
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna Commercial |
$240.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$146.06
|
| Rate for Payer: Health EOS Commercial |
$232.29
|
| Rate for Payer: HFN Commercial |
$240.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$195.75
|
| Rate for Payer: Multiplan Commercial |
$208.80
|
| Rate for Payer: NAPHCARE Commercial |
$156.60
|
| Rate for Payer: Preferred Network Access Commercial |
$240.12
|
| Rate for Payer: Quartz Beloit One Network |
$127.89
|
| Rate for Payer: Quartz Commercial |
$169.65
|
| Rate for Payer: Quartz Medicare Advantage |
$156.60
|
| Rate for Payer: The Alliance Commercial |
$1,044.00
|
| Rate for Payer: WEA Trust Commercial |
$143.55
|
| Rate for Payer: WPS Commercial |
$193.32
|
|
|
TRAY SPINAL ANESTHESIA B
|
Facility
|
IP
|
$261.00
|
|
| Hospital Charge Code |
2969065
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$127.89 |
| Max. Negotiated Rate |
$240.12 |
| Rate for Payer: Aetna Commercial |
$234.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$224.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.33
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna Commercial |
$240.12
|
| Rate for Payer: Health EOS Commercial |
$232.29
|
| Rate for Payer: HFN Commercial |
$240.12
|
| Rate for Payer: Multiplan Commercial |
$208.80
|
| Rate for Payer: NAPHCARE Commercial |
$156.60
|
| Rate for Payer: Preferred Network Access Commercial |
$240.12
|
| Rate for Payer: Quartz Beloit One Network |
$127.89
|
| Rate for Payer: Quartz Commercial |
$156.60
|
| Rate for Payer: WEA Trust Commercial |
$143.55
|
| Rate for Payer: WPS Commercial |
$193.32
|
|
|
TRAY SPINAL/EPIDURAL COMBINED NEPI-12093-20
|
Facility
|
IP
|
$656.00
|
|
| Hospital Charge Code |
4373908
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$321.44 |
| Max. Negotiated Rate |
$603.52 |
| Rate for Payer: Aetna Commercial |
$590.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$564.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$347.68
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cigna Commercial |
$603.52
|
| Rate for Payer: Health EOS Commercial |
$583.84
|
| Rate for Payer: HFN Commercial |
$603.52
|
| Rate for Payer: Multiplan Commercial |
$524.80
|
| Rate for Payer: NAPHCARE Commercial |
$393.60
|
| Rate for Payer: Preferred Network Access Commercial |
$603.52
|
| Rate for Payer: Quartz Beloit One Network |
$321.44
|
| Rate for Payer: Quartz Commercial |
$393.60
|
| Rate for Payer: WEA Trust Commercial |
$360.80
|
| Rate for Payer: WPS Commercial |
$485.90
|
|
|
TRAY SPINAL/EPIDURAL COMBINED NEPI-12093-20
|
Facility
|
OP
|
$656.00
|
|
| Hospital Charge Code |
4373908
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$183.68 |
| Max. Negotiated Rate |
$2,624.00 |
| Rate for Payer: Aetna Commercial |
$590.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$564.16
|
| Rate for Payer: Aetna Managed Medicare |
$183.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$426.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$328.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$314.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$347.68
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cigna Commercial |
$603.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$367.10
|
| Rate for Payer: Health EOS Commercial |
$583.84
|
| Rate for Payer: HFN Commercial |
$603.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$492.00
|
| Rate for Payer: Multiplan Commercial |
$524.80
|
| Rate for Payer: NAPHCARE Commercial |
$393.60
|
| Rate for Payer: Preferred Network Access Commercial |
$603.52
|
| Rate for Payer: Quartz Beloit One Network |
$321.44
|
| Rate for Payer: Quartz Commercial |
$426.40
|
| Rate for Payer: Quartz Medicare Advantage |
$393.60
|
| Rate for Payer: The Alliance Commercial |
$2,624.00
|
| Rate for Payer: WEA Trust Commercial |
$360.80
|
| Rate for Payer: WPS Commercial |
$485.90
|
|
|
TRAY THAL QUICK 12F CHEST TUBE G05464
|
Facility
|
OP
|
$2,311.00
|
|
| Hospital Charge Code |
6202989
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$647.08 |
| Max. Negotiated Rate |
$9,244.00 |
| Rate for Payer: Aetna Commercial |
$2,079.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,987.46
|
| Rate for Payer: Aetna Managed Medicare |
$647.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,502.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,155.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,109.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,224.83
|
| Rate for Payer: Cash Price |
$693.30
|
| Rate for Payer: Cigna Commercial |
$2,126.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,293.24
|
| Rate for Payer: Health EOS Commercial |
$2,056.79
|
| Rate for Payer: HFN Commercial |
$2,126.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,733.25
|
| Rate for Payer: Multiplan Commercial |
$1,848.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,386.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,126.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,132.39
|
| Rate for Payer: Quartz Commercial |
$1,502.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,386.60
|
| Rate for Payer: The Alliance Commercial |
$9,244.00
|
| Rate for Payer: WEA Trust Commercial |
$1,271.05
|
| Rate for Payer: WPS Commercial |
$1,711.76
|
|
|
TRAY THAL QUICK 12F CHEST TUBE G05464
|
Facility
|
IP
|
$2,311.00
|
|
| Hospital Charge Code |
6202989
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,132.39 |
| Max. Negotiated Rate |
$2,126.12 |
| Rate for Payer: Aetna Commercial |
$2,079.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,987.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,224.83
|
| Rate for Payer: Cash Price |
$693.30
|
| Rate for Payer: Cigna Commercial |
$2,126.12
|
| Rate for Payer: Health EOS Commercial |
$2,056.79
|
| Rate for Payer: HFN Commercial |
$2,126.12
|
| Rate for Payer: Multiplan Commercial |
$1,848.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,386.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,126.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,132.39
|
| Rate for Payer: Quartz Commercial |
$1,386.60
|
| Rate for Payer: WEA Trust Commercial |
$1,271.05
|
| Rate for Payer: WPS Commercial |
$1,711.76
|
|
|
TRAY THAL QUICK 32F CHEST TUBE G07242
|
Facility
|
OP
|
$2,084.00
|
|
| Hospital Charge Code |
6202991
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$583.52 |
| Max. Negotiated Rate |
$8,336.00 |
| Rate for Payer: Aetna Commercial |
$1,875.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,792.24
|
| Rate for Payer: Aetna Managed Medicare |
$583.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,354.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,042.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,000.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,104.52
|
| Rate for Payer: Cash Price |
$625.20
|
| Rate for Payer: Cigna Commercial |
$1,917.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,166.21
|
| Rate for Payer: Health EOS Commercial |
$1,854.76
|
| Rate for Payer: HFN Commercial |
$1,917.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,563.00
|
| Rate for Payer: Multiplan Commercial |
$1,667.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,250.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,917.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,021.16
|
| Rate for Payer: Quartz Commercial |
$1,354.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,250.40
|
| Rate for Payer: The Alliance Commercial |
$8,336.00
|
| Rate for Payer: WEA Trust Commercial |
$1,146.20
|
| Rate for Payer: WPS Commercial |
$1,543.62
|
|
|
TRAY THAL QUICK 32F CHEST TUBE G07242
|
Facility
|
IP
|
$2,084.00
|
|
| Hospital Charge Code |
6202991
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,021.16 |
| Max. Negotiated Rate |
$1,917.28 |
| Rate for Payer: Aetna Commercial |
$1,875.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,792.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,104.52
|
| Rate for Payer: Cash Price |
$625.20
|
| Rate for Payer: Cigna Commercial |
$1,917.28
|
| Rate for Payer: Health EOS Commercial |
$1,854.76
|
| Rate for Payer: HFN Commercial |
$1,917.28
|
| Rate for Payer: Multiplan Commercial |
$1,667.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,250.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,917.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,021.16
|
| Rate for Payer: Quartz Commercial |
$1,250.40
|
| Rate for Payer: WEA Trust Commercial |
$1,146.20
|
| Rate for Payer: WPS Commercial |
$1,543.62
|
|
|
TRAY TRANSFER SAFE-T-TRAY 31140398
|
Facility
|
OP
|
$84.00
|
|
| Hospital Charge Code |
2963216
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.52 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: Aetna Commercial |
$75.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.24
|
| Rate for Payer: Aetna Managed Medicare |
$23.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$54.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$40.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.52
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$77.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.01
|
| Rate for Payer: Health EOS Commercial |
$74.76
|
| Rate for Payer: HFN Commercial |
$77.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.00
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: NAPHCARE Commercial |
$50.40
|
| Rate for Payer: Preferred Network Access Commercial |
$77.28
|
| Rate for Payer: Quartz Beloit One Network |
$41.16
|
| Rate for Payer: Quartz Commercial |
$54.60
|
| Rate for Payer: Quartz Medicare Advantage |
$50.40
|
| Rate for Payer: The Alliance Commercial |
$336.00
|
| Rate for Payer: WEA Trust Commercial |
$46.20
|
| Rate for Payer: WPS Commercial |
$62.22
|
|
|
TRAY TRANSFER SAFE-T-TRAY 31140398
|
Facility
|
IP
|
$84.00
|
|
| Hospital Charge Code |
2963216
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.16 |
| Max. Negotiated Rate |
$77.28 |
| Rate for Payer: Aetna Commercial |
$75.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.52
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$77.28
|
| Rate for Payer: Health EOS Commercial |
$74.76
|
| Rate for Payer: HFN Commercial |
$77.28
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: NAPHCARE Commercial |
$50.40
|
| Rate for Payer: Preferred Network Access Commercial |
$77.28
|
| Rate for Payer: Quartz Beloit One Network |
$41.16
|
| Rate for Payer: Quartz Commercial |
$50.40
|
| Rate for Payer: WEA Trust Commercial |
$46.20
|
| Rate for Payer: WPS Commercial |
$62.22
|
|
|
TRAY UMBILICAL ARTERY 43201
|
Facility
|
OP
|
$853.00
|
|
| Hospital Charge Code |
2962920
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$238.84 |
| Max. Negotiated Rate |
$3,412.00 |
| Rate for Payer: Aetna Commercial |
$767.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$733.58
|
| Rate for Payer: Aetna Managed Medicare |
$238.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$554.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$426.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$409.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$452.09
|
| Rate for Payer: Cash Price |
$255.90
|
| Rate for Payer: Cigna Commercial |
$784.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$477.34
|
| Rate for Payer: Health EOS Commercial |
$759.17
|
| Rate for Payer: HFN Commercial |
$784.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$639.75
|
| Rate for Payer: Multiplan Commercial |
$682.40
|
| Rate for Payer: NAPHCARE Commercial |
$511.80
|
| Rate for Payer: Preferred Network Access Commercial |
$784.76
|
| Rate for Payer: Quartz Beloit One Network |
$417.97
|
| Rate for Payer: Quartz Commercial |
$554.45
|
| Rate for Payer: Quartz Medicare Advantage |
$511.80
|
| Rate for Payer: The Alliance Commercial |
$3,412.00
|
| Rate for Payer: WEA Trust Commercial |
$469.15
|
| Rate for Payer: WPS Commercial |
$631.82
|
|
|
TRAY UMBILICAL ARTERY 43201
|
Facility
|
IP
|
$853.00
|
|
| Hospital Charge Code |
2962920
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$417.97 |
| Max. Negotiated Rate |
$784.76 |
| Rate for Payer: Aetna Commercial |
$767.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$733.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$452.09
|
| Rate for Payer: Cash Price |
$255.90
|
| Rate for Payer: Cigna Commercial |
$784.76
|
| Rate for Payer: Health EOS Commercial |
$759.17
|
| Rate for Payer: HFN Commercial |
$784.76
|
| Rate for Payer: Multiplan Commercial |
$682.40
|
| Rate for Payer: NAPHCARE Commercial |
$511.80
|
| Rate for Payer: Preferred Network Access Commercial |
$784.76
|
| Rate for Payer: Quartz Beloit One Network |
$417.97
|
| Rate for Payer: Quartz Commercial |
$511.80
|
| Rate for Payer: WEA Trust Commercial |
$469.15
|
| Rate for Payer: WPS Commercial |
$631.82
|
|
|
TRAY UNIVERSAL BLOCK 181A143
|
Facility
|
OP
|
$574.00
|
|
| Hospital Charge Code |
4595216
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$160.72 |
| Max. Negotiated Rate |
$2,296.00 |
| Rate for Payer: Aetna Commercial |
$516.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$493.64
|
| Rate for Payer: Aetna Managed Medicare |
$160.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$373.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$287.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$275.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$304.22
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cigna Commercial |
$528.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$321.21
|
| Rate for Payer: Health EOS Commercial |
$510.86
|
| Rate for Payer: HFN Commercial |
$528.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$430.50
|
| Rate for Payer: Multiplan Commercial |
$459.20
|
| Rate for Payer: NAPHCARE Commercial |
$344.40
|
| Rate for Payer: Preferred Network Access Commercial |
$528.08
|
| Rate for Payer: Quartz Beloit One Network |
$281.26
|
| Rate for Payer: Quartz Commercial |
$373.10
|
| Rate for Payer: Quartz Medicare Advantage |
$344.40
|
| Rate for Payer: The Alliance Commercial |
$2,296.00
|
| Rate for Payer: WEA Trust Commercial |
$315.70
|
| Rate for Payer: WPS Commercial |
$425.16
|
|
|
TRAY UNIVERSAL BLOCK 181A143
|
Facility
|
IP
|
$574.00
|
|
| Hospital Charge Code |
4595216
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$281.26 |
| Max. Negotiated Rate |
$528.08 |
| Rate for Payer: Aetna Commercial |
$516.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$493.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$304.22
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cigna Commercial |
$528.08
|
| Rate for Payer: Health EOS Commercial |
$510.86
|
| Rate for Payer: HFN Commercial |
$528.08
|
| Rate for Payer: Multiplan Commercial |
$459.20
|
| Rate for Payer: NAPHCARE Commercial |
$344.40
|
| Rate for Payer: Preferred Network Access Commercial |
$528.08
|
| Rate for Payer: Quartz Beloit One Network |
$281.26
|
| Rate for Payer: Quartz Commercial |
$344.40
|
| Rate for Payer: WEA Trust Commercial |
$315.70
|
| Rate for Payer: WPS Commercial |
$425.16
|
|
|
TRAY UROLOGIST DISP 123400
|
Facility
|
IP
|
$3,002.00
|
|
| Hospital Charge Code |
2962998
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,470.98 |
| Max. Negotiated Rate |
$2,761.84 |
| Rate for Payer: Aetna Commercial |
$2,701.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,581.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,591.06
|
| Rate for Payer: Cash Price |
$900.60
|
| Rate for Payer: Cigna Commercial |
$2,761.84
|
| Rate for Payer: Health EOS Commercial |
$2,671.78
|
| Rate for Payer: HFN Commercial |
$2,761.84
|
| Rate for Payer: Multiplan Commercial |
$2,401.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,801.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,761.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,470.98
|
| Rate for Payer: Quartz Commercial |
$1,801.20
|
| Rate for Payer: WEA Trust Commercial |
$1,651.10
|
| Rate for Payer: WPS Commercial |
$2,223.58
|
|
|
TRAY UROLOGIST DISP 123400
|
Facility
|
OP
|
$3,002.00
|
|
| Hospital Charge Code |
2962998
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$840.56 |
| Max. Negotiated Rate |
$12,008.00 |
| Rate for Payer: Aetna Commercial |
$2,701.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,581.72
|
| Rate for Payer: Aetna Managed Medicare |
$840.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,951.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,501.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,440.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,591.06
|
| Rate for Payer: Cash Price |
$900.60
|
| Rate for Payer: Cigna Commercial |
$2,761.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,679.92
|
| Rate for Payer: Health EOS Commercial |
$2,671.78
|
| Rate for Payer: HFN Commercial |
$2,761.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,251.50
|
| Rate for Payer: Multiplan Commercial |
$2,401.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,801.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,761.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,470.98
|
| Rate for Payer: Quartz Commercial |
$1,951.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,801.20
|
| Rate for Payer: The Alliance Commercial |
$12,008.00
|
| Rate for Payer: WEA Trust Commercial |
$1,651.10
|
| Rate for Payer: WPS Commercial |
$2,223.58
|
|
|
Trazodone Level
|
Facility
|
OP
|
$158.00
|
|
|
Service Code
|
CPT 80338
|
| Hospital Charge Code |
3256241
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.24 |
| Max. Negotiated Rate |
$632.00 |
| Rate for Payer: Aetna Commercial |
$142.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.88
|
| Rate for Payer: Aetna Managed Medicare |
$44.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$102.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$79.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$75.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.74
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cigna Commercial |
$145.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$88.42
|
| Rate for Payer: Health EOS Commercial |
$140.62
|
| Rate for Payer: HFN Commercial |
$145.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$118.50
|
| Rate for Payer: Multiplan Commercial |
$126.40
|
| Rate for Payer: NAPHCARE Commercial |
$94.80
|
| Rate for Payer: Preferred Network Access Commercial |
$145.36
|
| Rate for Payer: Quartz Beloit One Network |
$77.42
|
| Rate for Payer: Quartz Commercial |
$102.70
|
| Rate for Payer: Quartz Medicare Advantage |
$94.80
|
| Rate for Payer: The Alliance Commercial |
$632.00
|
| Rate for Payer: United Healthcare PPO |
$118.50
|
| Rate for Payer: WEA Trust Commercial |
$86.90
|
| Rate for Payer: WPS Commercial |
$117.03
|
|
|
Trazodone Level
|
Professional
|
Both
|
$158.00
|
|
|
Service Code
|
CPT 80338
|
| Hospital Charge Code |
3256241
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.01 |
| Max. Negotiated Rate |
$150.10 |
| Rate for Payer: Aetna Commercial |
$150.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.88
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cigna Commercial |
$150.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$79.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$94.80
|
| Rate for Payer: Health EOS Commercial |
$143.78
|
| Rate for Payer: HFN Commercial |
$150.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45.01
|
| Rate for Payer: Multiplan Commercial |
$126.40
|
| Rate for Payer: Preferred Network Access Commercial |
$150.10
|
| Rate for Payer: Quartz Beloit One Network |
$69.52
|
| Rate for Payer: Quartz Commercial |
$90.06
|
| Rate for Payer: The Alliance Commercial |
$79.00
|
| Rate for Payer: WEA Trust Commercial |
$86.90
|
| Rate for Payer: WPS Commercial |
$117.03
|
|
|
Trazodone Level
|
Facility
|
IP
|
$158.00
|
|
|
Service Code
|
CPT 80338
|
| Hospital Charge Code |
3256241
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$77.42 |
| Max. Negotiated Rate |
$145.36 |
| Rate for Payer: Aetna Commercial |
$142.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.74
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cigna Commercial |
$145.36
|
| Rate for Payer: Health EOS Commercial |
$140.62
|
| Rate for Payer: HFN Commercial |
$145.36
|
| Rate for Payer: Multiplan Commercial |
$126.40
|
| Rate for Payer: NAPHCARE Commercial |
$94.80
|
| Rate for Payer: Preferred Network Access Commercial |
$145.36
|
| Rate for Payer: Quartz Beloit One Network |
$77.42
|
| Rate for Payer: Quartz Commercial |
$94.80
|
| Rate for Payer: WEA Trust Commercial |
$86.90
|
| Rate for Payer: WPS Commercial |
$117.03
|
|
|
TR Band
|
Facility
|
OP
|
$888.00
|
|
| Hospital Charge Code |
5184606
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$248.64 |
| Max. Negotiated Rate |
$3,552.00 |
| Rate for Payer: Aetna Commercial |
$799.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$763.68
|
| Rate for Payer: Aetna Managed Medicare |
$248.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$577.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$444.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$426.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$470.64
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cigna Commercial |
$816.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$496.92
|
| Rate for Payer: Health EOS Commercial |
$790.32
|
| Rate for Payer: HFN Commercial |
$816.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$666.00
|
| Rate for Payer: Multiplan Commercial |
$710.40
|
| Rate for Payer: NAPHCARE Commercial |
$532.80
|
| Rate for Payer: Preferred Network Access Commercial |
$816.96
|
| Rate for Payer: Quartz Beloit One Network |
$435.12
|
| Rate for Payer: Quartz Commercial |
$577.20
|
| Rate for Payer: Quartz Medicare Advantage |
$532.80
|
| Rate for Payer: The Alliance Commercial |
$3,552.00
|
| Rate for Payer: WEA Trust Commercial |
$488.40
|
| Rate for Payer: WPS Commercial |
$657.74
|
|
|
TR Band
|
Facility
|
IP
|
$888.00
|
|
| Hospital Charge Code |
5184606
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$435.12 |
| Max. Negotiated Rate |
$816.96 |
| Rate for Payer: Aetna Commercial |
$799.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$763.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$470.64
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cigna Commercial |
$816.96
|
| Rate for Payer: Health EOS Commercial |
$790.32
|
| Rate for Payer: HFN Commercial |
$816.96
|
| Rate for Payer: Multiplan Commercial |
$710.40
|
| Rate for Payer: NAPHCARE Commercial |
$532.80
|
| Rate for Payer: Preferred Network Access Commercial |
$816.96
|
| Rate for Payer: Quartz Beloit One Network |
$435.12
|
| Rate for Payer: Quartz Commercial |
$532.80
|
| Rate for Payer: WEA Trust Commercial |
$488.40
|
| Rate for Payer: WPS Commercial |
$657.74
|
|
|
Treanda 1 mg Charge
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
HCPCS J9034
|
| Hospital Charge Code |
2958920
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.76 |
| Max. Negotiated Rate |
$61.64 |
| Rate for Payer: Aetna Commercial |
$60.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.62
|
| Rate for Payer: Aetna Managed Medicare |
$14.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.16
|
| Rate for Payer: Anthem Medicare Advantage |
$14.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$35.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.76
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$61.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.30
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.76
|
| Rate for Payer: Health EOS Commercial |
$59.63
|
| Rate for Payer: HFN Commercial |
$61.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.76
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.76
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.76
|
| Rate for Payer: Multiplan Commercial |
$53.60
|
| Rate for Payer: NAPHCARE Commercial |
$22.13
|
| Rate for Payer: Preferred Network Access Commercial |
$61.64
|
| Rate for Payer: Quartz Beloit One Network |
$32.83
|
| Rate for Payer: Quartz Commercial |
$43.55
|
| Rate for Payer: Quartz Medicare Advantage |
$14.76
|
| Rate for Payer: The Alliance Commercial |
$59.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.76
|
| Rate for Payer: WEA Trust Commercial |
$36.85
|
| Rate for Payer: Wellcare Medicare |
$14.76
|
| Rate for Payer: WPS Commercial |
$34.58
|
|
